Pediatric Bipolar Disorder: Underdiagnosed or Fiction?
Daniel L. Sahling, MA
Columbia University, Teachers College
Diagnoses of children with pediatric bipolar disorder (PBD) have surged in recent years. This article explores three alternative explanations for the increase in these diagnoses: (a) PBD had previously beenunrecognized and underdiagnosed by clinicians; (b) the symptoms of PBD are largely a result of iatrogenic effects and side effects of psychostimulant medications, for example, Ritalin and Adderall; and (c) changes to the diagnostic system now classify previously normal behaviors of childhood as symptoms of PBD. After reviewing the evidence, this article concludes that the increase in diagnoses isprimarily due to the iatrogenic effects of psychostimulant medications and to the changes to the diagnostic system, and is not a previously unrecognized or underdiagnosed illness of unknown origin.
Keywords: pediatric bipolar disorder; adverse drug reactions; iatrogenic; stimulants; mood disorders urrently, there is a great deal of controversy surrounding the increased diagnoses of bipolar disorderamong children. Between 1994 and 2003, there was a 40-fold increase in diagnosing bipolar disorder in children (Moreno, Laje, Blanco, Jiang, Schmidt, & Olfson, 2007), and the trend has continued to escalate since then (Carey, 2007). After carefully reviewing the available evidence, this article proposes that diagnosing children with bipolar disorder has less to do with science than it does withﬁnding new markets for the drug companies. Furthermore, other factors and long-standing theoretical explanations need to be considered to better understand the symptoms that surround this disorder and why it is being diagnosed more frequently. This article will examine three alternative explanations for the possible causes of pediatric bipolar disorder (PBD).
1. Many instances of PBD had previouslygone unrecognized and been undiagnosed, as claimed by some researchers. 2. Stimulant medications and their side effects are the main causes of the symptoms—the iatrogenic explanation. 3. Changes in the current diagnostic system for PBD contribute to classifying previously normal childhood behaviors as maladaptive.
Other sections will explore the biomedical theories that are claimed tocause or predispose an individual for these disorders. The last part of the discussion will focus around methods of treatment for children diagnosed as bipolar.
© 2009 Springer Publishing Company
Children diagnosed as having PBD have often also been previously diagnosed as having attention-deﬁcit/hyperactive disorder(ADHD). Children diagnosed with ADHD are often prescribed a psychostimulant medication such as Ritalin (Gadow, 1991; Maalouf, Ziegler, Schlozman, & Prince, 2006; Seitler, 2006). The effects and side effects of Ritalin or similar drugs can result in a series of iatrogenically induced symptoms resembling cycles of mania and depression (“Bipolar Disorder in Children,” 2007; Koehler-Troy, Strober, &Malenbaum, 1986; Olfman, 2007; Singh, DelBello, Kowatch, & Strakowski, 2006). These symptoms, in turn, often lead to mistaken diagnoses of PBD, followed by prescriptions for either Lithium or an atypical antipsychotic drug such as risperidone (Maalouf et al., 2006). These mood stabilizer and atypical antipsychotic drugs, if overused even for a brief period, can result in brain shrinkage anddysfunction and have been shown to inhibit children’s growth, development, and social functioning (Breggin, 1991, 1994, 1999; Carlezon, Mague, & Anderson, 2003; Fischer & Barner, 1977; Maalouf et al., 2006; Silverman & Treisman, 2006). Meanwhile, many psychiatrists as well as a large segment of the public maintain that ADHD and bipolar disorder are real physiological problems that can contribute to...